Case at a glance
- Previous treatment
- Surgical plan
- Removal of contracted scar tissue: We carefully removed the thick scar tissue beneath the nasal tip skin.
- Tip reconstruction: Perichondrium and finely crushed cartilage from the patient's own rib were placed beneath the depressed skin to restore volume and coverage.
- Intranasal mucosal advancement flap: A flap of tissue from the lining inside the nose was advanced to provide sufficient coverage for closure.
- Graft & material details
- Tip reconstruction: Perichondrium and finely crushed cartilage from the patient's own rib were placed beneath the depressed skin to restore volume and coverage.
- Bridge implant adjustment: Differences in the thickness of the bridge skin created an uneven contour. A precisely fitted silicone implant was used to achieve a smoother, more natural bridge.
- Photo timing
These details are excerpts from the original article and captions. Follow a detail to read it in context.
Hello, I am Dr. Peter C. Kang, Medical Director of NOSELAB Clinic. Today, I would like to share a revision rhinoplasty case in which inflammation after previous surgery had caused scar contracture and deformity of the nasal tip.
Surgical History
The patient previously underwent nasal implant placement and alar base reduction at another clinic. Inflammation subsequently developed around the columella, the tissue between the nostrils. Injectable antibiotics did not improve the condition. Because the patient was pregnant at the time, treatment was limited to emergency drainage of pus with a needle.
After giving birth, the patient underwent surgery to remove the implant and all other graft materials. However, longstanding inflammation had produced thick contracted scar tissue beneath the tip skin, leaving the tip depressed and distorted.
The Patient's Goals
Create a slimmer, more natural-looking nasal tip.
Restore the indented and depressed areas left after the earlier needle treatment.
Improve nostril asymmetry.
Surgical Plan and Procedure
Removal of contracted scar tissue: We carefully removed the thick scar tissue beneath the nasal tip skin.
Tip reconstruction: Perichondrium and finely crushed cartilage from the patient's own rib were placed beneath the depressed skin to restore volume and coverage. Rib cartilage was also used to rebuild a firm supporting framework for the tip.
Intranasal mucosal advancement flap: A flap of tissue from the lining inside the nose was advanced to provide sufficient coverage for closure.
Bridge implant adjustment: Differences in the thickness of the bridge skin created an uneven contour. A precisely fitted silicone implant was used to achieve a smoother, more natural bridge.
Surgical Results
Frontal view
Restoring the depressed and distorted areas of the tip produced a more natural overall contour.
Nostril asymmetry improved, creating a more balanced appearance.
Profile view
The tip was reconstructed at an appropriate projection and angle, creating a natural profile.
Correction of the nasolabial angle, the angle between the nose and upper lip, improved overall facial balance.
Overall appearance
Improvement of the longstanding tip deformity is expected to help the patient feel more confident about the nose.
Surgeon's Perspective
A nose affected by post-inflammatory scar contracture often requires a more complex approach than routine revision rhinoplasty. When thick contracted scar tissue is present, simply inserting another graft may be insufficient. Adequate scar release and removal must be combined with structural reconstruction using the patient's own cartilage.
In this case, removal of the contracted tissue and reconstruction with autologous rib cartilage provided a firm, natural-looking tip. Using the patient's own tissue also helped reduce concerns about foreign-body reactions and further inflammation in the reconstructed area.
Thank you for reading. I am Dr. Peter C. Kang, Medical Director of NOSELAB Clinic.
Information About These Photographs and Surgical Risks
These before-and-after photographs show an individual patient's results. Discuss your expected outcome with your doctor.
All surgery carries a risk of complications, including the following:
Infection: Disinfection and injectable or oral antibiotics are used to help prevent infection. In rare cases (less than 0.5%), another operation may be required.
Bleeding: Nasal packing is used for one to two days to help minimize bleeding. Bleeding may occasionally occur after surgery for nasal inflammation or obstruction.
Allergic reactions.
Residual asymmetry: Facial asymmetry and the condition of the nose may prevent complete correction, as explained during consultation.
Insufficient cosmetic or functional improvement.
Other complications, including excessive scar formation and skin necrosis.
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